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08 April 2022, Volume 26 Issue 10 Previous Issue    Next Issue

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Analysis of the risk for bone cement leakage after percutaneous vertebroplasty in osteoporosis patients and model verification Li Wenle, Wang Haosheng, Ning Lijun, Zhang Wenshi, Gao Sen, Sun Lijun, Hu Zhaohui 2022, 26 (10):  1477-1482.  doi: 10.12307/2022.190 Abstract ( 656 )   PDF (22670KB) ( 267 )   Save BACKGROUND: Cement leakage is the most common complication of percutaneous vertebroplasty, but the risk factors for cement leakage are still under debate. OBJECTIVE: To investigate the risk factors of bone cement leakage after percutaneous vertebroplasty, establish and verify the prediction model.  METHODS: Data of 385 patients with osteoporotic compression fractures that received percutaneous vertebroplasty in the Department of Spinal Surgery, Liuzhou People’s Hospital from June 2016 to June 2018 were retrospectively analyzed, including 77 males and 308 females. Age, sex, bone density, height, weight, body mass index, length of hospital stay, bone cement quantity, operation time, hospitalization to operation time, injury to operation time, whether more vertebral fractures, and steroid use in percutaneous vertebroplasty of postoperative bone cement leakage were analyzed using single factor and multiple factors analysis to identify the associated risk factors, and the forecast model was established and verified. This study was approved by the Institutional Review Committee of Liuzhou People’s Hospital. RESULTS AND CONCLUSION: (1) Bone cement leakage was observed in 81 of 385 patients. Single-factor Logistic regression analysis results showed that the injection amount of bone cement, operation duration and multiple vertebral fractures were correlated with bone cement leakage (P < 0.05). Multivariate Logistic regression analysis showed that higher bone cement injection volume [OR=1.283, 95%CI (1.004, 1.640), P < 0.05], longer operation time [OR=1.015, 95%CI (1.003, 1.027), P < 0.05] and multiple vertebral fractures [OR=2.456, 95%CI (1.461, 4.130), P < 0.05] patients had a greater risk of bone cement leakage. (2) The Nomogram was further established and validated. Results demonstrated that ROC=0.683, and the goodness of fit test result P=0.592, suggesting that the model has good predictive ability. (3) Results suggested that the injection amount of bone cement, operation time and multi-vertebral fracture were the risk factors for bone cement leakage after percutaneous vertebroplasty. Nomogram established can exactly predict the occurrence of bone cement leakage after percutaneous vertebroplasty.   Figures and Tables | References | Related Articles | Metrics

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Bone cement interval perfusion in hyperextension position for treatment of senile osteoporotic vertebral compression fractures Che Yanjun, Hu Dan, Si Weibing, Gu Xueping, Hao Yuefeng 2022, 26 (10):  1483-1489.  doi: 10.12307/2022.191 Abstract ( 512 )   PDF (848KB) ( 312 )   Save BACKGROUND: Vertebroplasty in the treatment of osteoporotic vertebral compression fracture has experienced more than 20 years of clinical practice, but the intraoperative bone cement leakage is still a difficult clinical problem. OBJECTIVE: To evaluate the efficacy of bone cement interval perfusion in hyperextension position for treatment of senile osteoporotic vertebral compression fractures.   METHODS: Between May 2015 and December 2020, 120 patients who suffered from osteoporotic vertebral compression fractures were treated with percutaneous kyphoplasty in hyperextension position in the Affiliated Suzhou Hospital of Nanjing Medical University. The patients were at the age of ≥ 80 years. According to the way of bone cement perfusion, they were randomly divided into conventional bone cement injection group (n=60, bone cement mixed one-time injection) and bone cement interval perfusion combined reduction group (n=60, preoperative position reduction + bone cement perfusion at different times). Visual analogue scale score, Oswestry dability index, Cobb angle, anterior edge height of injured vertebra, improvement of lung function, and the occurrence of cement leakage were compared between the two groups 1 week postoperatively and during final follow-up. This study was approved by the Affiliated Suzhou Hospital of Nanjing Medical University (approval No. KL901173).  RESULTS AND CONCLUSION: (1) Both groups were followed up for more than 12 months after surgery. The bone cement leakage rate in the bone cement interval perfusion combined reduction group was lower than that in the conventional bone cement injection group (3.3%, 15.0%, P < 0.05). (2) The visual analogue scale score and Oswestry dability index of the two groups after surgery were lower than those before operation (P < 0.05), and there was no significant difference between the two groups (P > 0.05). (3) The postoperative Cobb angle of the injured vertebrae and anterior edge height of injured vertebra were significantly improved compared with that before operation. The Cobb angle and anterior edge height of injured vertebra in the bone cement interval perfusion combined reduction group were better than those in the conventional bone cement injection group at 1 week after operation and the last follow-up (P < 0.05). (4) The forced vital capacity and maximum voluntary ventilation of patients in the conventional bone cement injection group were significantly improved after surgery compared with those after surgery (P < 0.05). The postoperative vital capacity, forced vital capacity and maximum voluntary ventilation in the bone cement interval perfusion combined reduction group were significantly improved compared with preoperative data (P < 0.05). Vital capacity, forced vital capacity, and maximum voluntary ventilation in the bone cement interval perfusion combined reduction group 1 week after operation and the last follow-up were higher than those of the conventional bone cement injection group (P < 0.05). (5) The results showed that satisfactory imaging and clinical results can be obtained by the method of bone cement interval perfusion in hyperextension position. This method can significantly reduce the incidence of bone cement leakage and improve lung function.  Figures and Tables | References | Related Articles | Metrics

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Kyphoplasty with high viscosity bone cement for the treatment of stage III Kümmell disease without neurological symptoms: restoration of vertebral body height, reduction of kyphoplasty and restoration of column sagittal sequence Shi Yan, Zhang Yunqing, Liu Yong, Rui Min, Liu Shanglou 2022, 26 (10):  1490-1494.  doi: 10.12307/2022.192 Abstract ( 501 )   PDF (20961KB) ( 353 )   Save BACKGROUND: Percutaneous kyphoplasty is widely used in the treatment of stage I and II Kümmell disease, which can rapidly relieve pain, stabilize vertebral body and correct kyphosis; however, the treatment of stage III Kümmell disease is still controversial. OBJECTIVE: To evaluate the clinical outcome of kyphoplasty with high-viscosity bone cement for treatment of stage III Kümmell disease without neurologic symptoms.  METHODS: Twenty-eight patients (11 males and 17 females, aged 57-82 years) with stage III Kümmell disease without neurologic symptoms were admitted to Jiangyin People’s Hospital from May 2016 to May 2019, in which T11 vertebral body in 6 cases and T12 vertebral body in 14 cases, L1 vertebral body in 5 cases and L2 vertebral body in 3 cases were treated by kyphoplasty with high viscosity bone cement. At 1 day after operation and 1 year after follow up, postoperative pain and improvement of life ability were evaluated by the Visual Analogue Scale and Oswestry Disability Index. The recovery of vertebral height and correction of kyphosis were measured with X-ray films. The study was approved by the Ethics Committee of Jiangyin People’s Hospital, approval No. [2017](021).  RESULTS AND CONCLUSION: (1) Totally 28 patients were followed up for 12-22 months. No serious complications such as wound infection or pulmonary embolism were found during treatment. Asymptomatic cement leakage occurred in three patients. Adjacent vertebral fracture was encountered in 1 patient at 3 months after operation, and healed after kyphoplasty. (2) Visual Analogue Scale, Oswestry Disability Index, and kyphotic angle were lower at 1 day and 1 year after operation than those before operation in 28 patients (P < 0.05). The height of anterior, middle and posterior edges of vertebral body at 1 day and 1 year after operation was higher than that before operation (P < 0.05). (3) The results showed that kyphoplasty with high-viscosity bone cement can relieve back pain, improve viability, retain the vertebral body height, reduce kyphosis, and restore spinal alignment, and is an effective method for treatment of stage III Kümmell disease.  Figures and Tables | References | Related Articles | Metrics

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Application of meniscus suture wrapped by suture device versus traditional total internal suture device in the treatment of lateral meniscus popliteal tendon injury  Xing Jisi, Lu Mingfeng, Zhao Lilian, He Lilei, Liu Xiaofang 2022, 26 (10):  1495-1500.  doi: 10.12307/2022.193 Abstract ( 712 )   PDF (24909KB) ( 500 )   Save BACKGROUND: To preserve the annular structure of the lateral meniscus and the function of the knee joint as much as possible. At present, there are two kinds of suture methods commonly used in arthroscopic repair of lateral meniscus popliteal tendon hiatus area injury: total internal suture and inside-out suture. All of them have some shortcomings. OBJECTIVE: To investigate the difference of clinical efficacy between arthroscopic meniscal suture with suture device wrapping and total internal suture device in repairing lateral meniscus popliteal tendon hiatus injury. METHODS: Totally 84 patients with lateral meniscus popliteal tendon injury treated in the Foshan Hospital of Traditional Chinese Medicine from January to December 2019 were enrolled in this study. The patients, aged 23-32 years, were divided into two groups: the meniscus suture passer group (n=40) and total internal suture device group (n=44). The operation time, the number of stitches and the total cost of hospitalization were collected in the two groups. IKDC score, Lysholm score and Tegner score were used to evaluate knee joint function before and after operation. Simultaneously, Barrett evaluation criteria, MRI examination and secondary arthroscopic exploration were used to evaluate the meniscus healing. This study was approved by Ethics Committee of Foshan Hospital of Traditional Chinese Medicine (approval No. 20191230).   RESULTS AND CONCLUSION: (1) The incisions of 84 patients healed in the first stage after operation, and there were no complications such as joint infection or foreign body rejection. The patients were followed up for 12-24 months. There was no significant difference in the number of suture needles and operation time between the two groups (P > 0.05). The cost of hospitalization in the meniscus suture passer group was lower than that in the total internal suture device group (P < 0.05). (2) There was no significant difference in IKDC score, Lysholm score, and Tegner score between the two groups at the last follow-up (P > 0.05). (3) At the last follow-up, according to Barrett’s evaluation criteria, there was no significant difference in the clinical healing rate between the two groups (P > 0.05). At the last follow-up, MRI showed that there was no significant difference in the complete healing rate and total healing rate between the two groups (P > 0.05). (4) Thirty-six patients (18 cases in the meniscus suture passer group and 18 cases in the total internal suture device group) underwent secondary arthroscopic exploration at 12-24 months after surgery. There was no significant difference in the complete healing rate and total healing rate between the two groups (P > 0.05). (5) The conclusion shows that using meniscus suture passer to repair the injury of popliteal tendon hiatus of lateral meniscus is a safe, reliable, convenient, and effective method, has high healing rate. Figures and Tables | References | Related Articles | Metrics

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Effect of osteogenesis in patients with alveolar cleft after bone grafting investigated by volume analysis Gu Yueguang, Shen Jianhuan, Ni Jieli, Guo Shuyu, Yan Zhongyi, Zhang Yang 2022, 26 (10):  1501-1504.  doi: 10.12307/2022.194 Abstract ( 603 )   PDF (21508KB) ( 257 )   Save BACKGROUND: Preserving bone after bone grafting in patients with alveolar cleft is crucial. Currently, most studies on alveolar cleft used two-dimensional measurement; only a single measurement evaluation method was used even if some studies used three-dimensional measurement using cone beam CT. The amount of bone formation measured varies greatly. OBJECTIVE: To investigate the osteogenic effect in patients with alveolar cleft 1 year after bone grafting and to analyze the influencing factors such as canine eruption and preoperative defect size using cone beam CT combined with Mimics software.  METHODS: Twenty-one patients with unilateral complete alveolar cleft were included. One year after the iliac bone grafting, the volume of the alveolar cleft defect in maxillary bone (the entire alveolar cleft defect area) and alveolar bone (near the defect area of the oral cavity) were measured by cone beam CT combined with Mimics software. The osteogenic effect of these two areas and whether the eruption of the canine affected the bone stock were analyzed.  RESULTS AND CONCLUSION: (1) After bone transplantation, the amount of osteogenesis in the maxillary cleft defect was ralatively low, while the amount of osteogenesis in the alveolar ridge cleft defect was relatively high. The amount of osteogenesis was higher before the eruption of canine than that after the eruption of canine at the defect area (P < 0.05). There was no correlation between the postoperative osteogenic effect of the alveolar cleft defect area and the preoperative volume of the defect area. (2) The results showed that the osteogenic effect of the alveolar ridge defect area was higher than that of the whole defect area, and the alveolar ridge defect area should be taken as the basis to guide the subsequent orthodontic and prosthodontics treatment. Moreover, bone grafting should be performed before the eruption of canine.   Figures and Tables | References | Related Articles | Metrics

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Biomechanical changes in different implantation and fixation methods of lumbar fusion cage Nie Wenzhong, Li Xiaoxuan, Zeng Jiayi, Shi Changqiang 2022, 26 (10):  1505-1509.  doi: 10.12307/2022.195 Abstract ( 640 )   PDF (23334KB) ( 171 )   Save BACKGROUND: For lumbar degenerative spondylolisthesis, segmental instability, and discogenic diseases, lumbar fixation and fusion are generally required for non-operative treatment. Unilateral internal fixation and bilateral internal fixation are the two main internal fixation methods for the treatment of degenerative diseases of the lumbar spine. OBJECTIVE: To explore the influence of different fixation methods before and after bone cement injection on the lumbar spine from the perspective of biomechanics by finite element method.  METHODS: A total of 632 pieces of L1-S segments in the CT data of the National 973 Project of the “Digital Astronaut” were selected, and the interval between layers was 0.625 mm. The medical image processing software Mimics 10.0 was used to read in the scanned DICOM files to reconstruct the model of the lower lumbar spine L1-S. UG, MIMICS and other software were used to establish five kinds of human lumbar spine three-dimensional models with L3-5 normal, single fusion cage unilateral fixation and bilateral internal fixation, cage-bone cement perfusion unilateral fixation and bilateral internal fixation. Through the finite element analysis method, range of motion of L3-4 vertebral body joint, L3-4 fibrous annulus maximum stress, L3-4 nucleus pulposus internal pressure, the peak stress of the lower endplate of L4 and the peak stress of the pedicle internal fixation system were compared in the five models to simulate the human lumbar spine flexion, extension, lateral flexion, and rotation.  RESULTS AND CONCLUSION: (1) Compared with the normal model, the pressure of the posterior extension of the fiber ring was increased by 54% in the simple fusion cage placement group. The pressure of the fiber ring was the highest when the single fusion cage was fixed in one side. In the fusion-cement perfusion group, bilateral internal fixation was reduced by 2%, 7%, 3%, and 3%, respectively, compared with that in the simple fusion-cement infusion group. In the fusion-cement perfusion group, the stress of the vertebral pedicle was reduced by 8%, 3%, 3%, 5% in bilateral internal fixation compared with that of the unilateral pedicle under flexion, extension, flexion, and rotation. (2) It is concluded that in the case of the support of the fusion device, there is no big difference in stability between unilateral and bilateral fixation. The stability of the lumbar spine can be basically guaranteed after the placement of the fusion device and the injection of bone cement. Figures and Tables | References | Related Articles | Metrics

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Construction of icariin/polycaprolactone nanofiber membrane and its osteogenic ability in vitro Dong Zhiheng, Gao Yan, Liu Zhen, Han Xiaoqian 2022, 26 (10):  1510-1514.  doi: 10.12307/2022.196 Abstract ( 691 )   PDF (20765KB) ( 176 )   Save BACKGROUND: In bone tissue engineering, the application of electrospinning makes bone growth factor play a long-term role. Icariin has been shown to promote the proliferation of MC3T3-E1 cells.  OBJECTIVE: To construct icariin/polycaprolactone nanofiber membrane, and evaluate its biocompatibility and osteogenic ability in vitro.  METHODS: Coaxial electrospinning technology was used to prepare icariin/polycaprolactone nanofiber membrane, and their morphology and drug release in vitro were characterized. MC3T3-E1 cells were cultured in vitro and divided into four groups. The blank group was treated with conventional culture. The nanofiber membrane group was treated with polycaprolactone nanofiber membrane. The drug group was treated with medium containing icariin. The experimental group was treated with icariin/polycaprolactone nanofiber membrane. Cytoskeleton morphology, proliferation, alkaline phosphatase activity, and osteocalcin mRNA expression were detected in each group.  RESULTS AND CONCLUSION: (1) Scanning electron microscope revealed that the icariin-loaded/ polycaprolactone electrospinning nanofiber membrane showed a three-dimensional structure, uniform void size, aperture of 100-200 µm, distribution range of 300-600 nm. (2) The cumulative drug release of icariin/polycaprolactone nanofiber membrane observed within one month demonstrated that the drug release was about 45% in the first 1-5 days. The drug release was slow and sustained in the later period, and more than 80% in the 30 days. (3) After 24 hours of culture, laser confocal microscopy showed that the cells adhered to the nanofiber membrane, and the actin and internal structure of the cells were clear. (4) CCK-8 assay exhibited that the cell proliferation of the experimental group was faster than that of the other three groups at 4 and 7 days (P < 0.05). (5) Alkaline phosphatase activity was higher in the experimental group than that in the other three groups at 7, 14, and 21 days (P < 0.05). Osteocalcin mRNA expression was higher in the experimental group than that in the other three groups at 7 days after culture (P < 0.05). (6) The results show that electrospinning can be used to construct icariin/polycaprolactone nanofiber membrane, which has good drug release and bone promoting properties in vitro.  Figures and Tables | References | Related Articles | Metrics

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Preparation and performance of rifampicin-silk fibroin microspheres An Tiantian, Xu Yan, Chen Huiming, Zhang Xujing, Tan Hao 2022, 26 (10):  1515-1521.  doi: 10.12307.2022.197 Abstract ( 568 )   PDF (60598KB) ( 64 )   Save BACKGROUND: At present, the most common choice for treatment of bone joint tuberculosis is oral and systemic anti-tuberculosis drugs, but drug-resistant tuberculosis strains and drug side effects are prone to occur, and the local drug concentration is low at the lesion. Biodegradable microspheres buried in the lesions can be given at a specific point, delay drug release and control the rate of release, providing a new treatment for the treatment of bone joint tuberculosis. OBJECTIVE: To design orthogonal experiments to optimize the preparation process parameters of rifampicin-loaded silk fibroin microspheres, and prepare sustained-release microspheres with round morphology, uniform particle size, high drug loading and encapsulation rates, and to explore the release behavior of the microsphere in vitro drug experiment. METHODS: Using silk fibroin solution as the water phase, liquid paraffin as the oil phase, and Span-80 as the emulsifier, the silk fibroin drug-loaded microspheres loaded with rifampicin were prepared by the emulsification solvent positive method. Orthogonal experiment was designed to investigate stirring speed (300, 500, 700, 900 r/min), isopropanol and silk fibroin solution volume ratio (1:1, 2:1, 4:1, 6:1), water-oil volume ratio (1:6, 1:8, 1:10, 1:12), emulsifier content (2%, 4%, 6%, 8%) and temperature (25, 35, 45, 55 °C) influences on the morphology, drug loading rate and encapsulation rate of drug-loaded microspheres.  RESULTS AND CONCLUSION: Orthogonal experiment results showed that the best process parameters were the stirring speed of 900 r/min, the volume ratio of isopropanol to silk fibroin solution of 1:1, the volume ratio of water to oil of 1:6, the Span-80 concentration of 2%, and the temperature of 55 °C. Under this condition to make silk fibroin microspheres, the surface of the microsphere was smooth, with good spherical effect; the microsphere size was about 11.18 µm; drug-loaded rate was 10.56%; encapsulated rate was 42.78%; cumulative release rate of 68.4% in 144 hours. Microsphere is stable and sustained on drug release, and has a good drug release effect. Figures and Tables | References | Related Articles | Metrics

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Polydopamine assisted salidroside to improve bone formation on micro-arc oxidation of pure titanium Liang Pengchen, Shi Junfeng, Sun Miaomiao, Liang Dongyu, Sha Shuang, Yi Qingqing, Chang Qing 2022, 26 (10):  1522-1529.  doi: 10.12307/2022.198 Abstract ( 646 )   PDF (179235KB) ( 64 )   Save BACKGROUND: Micro-arc oxidation technology has been used to improve the osseointegration of titanium implants. A variety of porous coatings containing different active elements are constructed on the surface of titanium. In recent years, studies have found that salidroside has good bone-promoting activity. Polydopamine, as an excellent binder on the surface of the material and a carrier for secondary adsorption, has the characteristics of loading active molecules.   OBJECTIVE: To further improve the bone-promoting ability of the micro-arc oxidation coating on the titanium surface, a composite coating with excellent osseointegration was constructed on the porous surface. METHODS:  The micro-arc oxidation coating was made on the surface of pure titanium, which was marked as MAO group, and the polydopamine coating was further prepared on the surface of micro-arc oxidation coating, which was marked as PDA group. Salidroside (1, 2, 4 g/L) was loaded on the surface of polydopamine coating, which was divided into Sal-1 group, Sal-2 group and Sal-4 group. The micro-morphology, surface element content and distribution of each coating were analyzed by scanning electron microscope and X-ray energy dispersive spectrometer. The proliferation activity of cells on the surface of each group was evaluated by CCK-8 assay and fluorescence staining, and the abilities of bone differentiation and mineralization were observed by alkaline phosphatase staining and alizarin red staining. The potential bone-promoting targets of salidroside were predicted by computer molecular docking technique.   RESULTS AND CONCLUSION: (1) Scanning electron microscope showed that the surface of the five groups of specimens had porous micron morphology and the average pore diameter was similar, and X-ray energy dispersive spectrometer analysis showed that salidroside could be loaded on the surface of micro-arc oxidation coating by polydopamine carrier. (2) CCK-8 experiment showed that the survival rate of MC3T3-E1 cells in Sal-2 group and Sal-4 group was higher than that in MAO group on the 3rd and 5th days of culture (P < 0.05). Fluorescence staining showed that there were significant differences in MC3T3-E1 morphology among the five groups, and compared with MAO group, Sal-2 group and Sal-4 group had better cell morphology, larger cell spreading area and better connection with neighboring cells. (3) The activity of alkaline phosphatase in Sal-2 group and Sal-4 group was higher than that in MAO group on the 4th and 7th days (P < 0.05). Alizarin red staining showed that calcium nodules appeared in all groups on the 21st day, especially in Sal-2 group and Sal-4 group. (4) Computer molecular docking results show that extracellular regulated protein kinases 2, c-Jun N-terminal kinase 3, estrogen receptor β, and progesterone receptor may be the more active targets for salidroside to promote bone formation. (5) The results showed that salidroside was loaded on the surface of titanium micro-arc oxidation coating by polydopamine, and the bone-promoting activity of micro-arc oxidation coating was improved by proper amount of salidroside. Figures and Tables | References | Related Articles | Metrics

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Manufacturing of nano-modified polycaprolactone microspheres and its biological effects in dental pulp cells Li Xuan, Sun Yimin, Li Longbiao, Wang Zhenming, Yang Jing, Wang Chenglin, Ye Ling 2022, 26 (10):  1530-1536.  doi: 10.12307/2022.199 Abstract ( 550 )   PDF (42946KB) ( 112 )   Save BACKGROUND: Polycaprolactone based scaffolds have potential in dental pulp regeneration since its good thermal stability, excellent biocompatibility and tunable degradation rate. However, its hydrophilicity and bioactivity are poor.     OBJECTIVE: To prepare microspheres with polycaprolactone-polydopamine-nano-hydroxyapatite (PCL-PDA-nHA), and explore its physical properties and the effects on the proliferation and mineralization of dental pulp cells. METHODS: The PCL microspheres were prepared by double emulsification method. The hydrophilicity and crystallinity were improved by the surface modification of dopamine and the PCL-PDA particles were obtained. Nano-hydroxyapatite coating was formed in situ on the surface of PCL-PDA microspheres by simulating body fluids (reaction 7-day group and reaction 14-day group) to obtain PCL-PDA-nHA microspheres. The physical and chemical properties of each group of microspheres were detected by scanning electron microscopy, X-ray photoelectron spectroscopy and protein adsorption experiment. Hemolysis test, coagulation factor activation test and platelet agglutination test were used to test the hemocompatibility of each group of microspheres. Four groups of microspheres were co-cultured with human dental pulp cells. Cell proliferation was detected by CCK-8 assay. The mineralization induction ability of the microspheres was analyzed using alkaline phosphatase, alizarin red and sirius red staining. RESULTS AND CONCLUSION: (1) Scanning electron microscopy showed that the four groups of microspheres were uniform and porous structure, and there was no significant difference in the diameter of microspheres; the porosity was 87.4% with pore diameter ranging from 20 μm to 50 μm. X-ray photoelectron spectroscopy showed that polydopamine and hydroxyapatite particles were successfully decorated on the microsphere surface. Protein adsorption experiment showed that the functional microspheres could enhance the adsorption of serum albumin. (2) Hemolysis experiment showed that the hemolysis rate of microspheres was below 1%, without obvious hemolysis. The coagulation factor activation experiment showed that each group of modified polycaprolactone microspheres had little effect on blood coagulation. Scanning electron microscopy showed that there was no obvious platelet aggregation on the surface of each group of microspheres. (3) CCK-8 assay demonstrated that cell proliferation on the surface of each group of modified microspheres was faster than that of PCL microspheres. (4) Alkaline phosphatase, alizarin red and sirius red staining exhibited that the mineralization induction ability of each group of modified microspheres was stronger than that of PCL microspheres, and the mineralization induction ability of PCL-PDA-nHA-14 day microspheres and PCL-PDA-nHA-7 day microspheres was stronger than that of PCL-PDA microspheres. (5) The results suggested that PCL-PDA-nHA nanospheres had good hemocompatibility, and could promote the proliferation and mineralization of human dental pulp cells.  Figures and Tables | References | Related Articles | Metrics

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Effect of peracetic acid/ethanol on the properties of allogeneic skin Hu Kai, Chen Weiming, Luo Jingwan, Li Miao, Wang Jingjing, Li Mao, Shen Yajun, Chen Jinfa, Bai Yulong 2022, 26 (10):  1537-1543.  doi: 10.12307/2022.200 Abstract ( 644 )   PDF (126732KB) ( 51 )   Save BACKGROUND: The peracetic acid/ethanol is an ideal reagent for inactivating viruses of animal derived tissues and allogeneic tissues. It is effective in killing pathogenic microorganisms. However, its effect on other properties of allogeneic skin has not been reported.   OBJECTIVE: To investigate the effect of peracetic acid/ethanol treatment on the performance of allogeneic skins. METHODS:  Three different concentrations of peracetic acid/ethanol solutions were prepared, which were 2.3 g/L peracetic acid + 24% v/v ethanol (set as P/E-1), 1.8 g/L peracetic acid + 4.8% v/v ethanol (set as P/E-2) and 15.33 g/L peroxyacetic acid + 24% v/v ethanol (set as P/E-3). Allogeneic skin was treated with different concentrations of peracetic acid/ethanol for 15, 30, 45 and 60 minutes, respectively. The structural properties of the skin were evaluated via appearance, histological staining, mechanical test and glycosaminoglycan content test. Besides, chemical reagent residues and cytotoxicity in the treated skin were also studied.   RESULTS AND CONCLUSION: (1) No significant difference in the epidermal appearance of skin were observed at all investigated concentrations of peracetic acid/ethanol. (2) Hematoxylin-eosin staining showed no obvious changes in the extracellular matrix structure of skin after 15 minutes of P/E-1 and P/E-2 treatment compared with untreated allogeneic skin, and the extracellular matrix structure of skin treated with more than 15 minutes was relatively loose which preserved an integral structure. However, microporous appeared in the dermis while it was treated for 15 minutes, especially after 15 minutes, more holes appeared in the dermis and the extracellular matrix structure was seriously destroyed. (3) The longer the treatment time at the same concentration, the lower the glycosaminoglycan content and the lower the mechanical strength and modulus. With the same treatment time, the tensile strength of the P/E-1 treatment group was the largest, while the P/E-3 treatment group was the smallest; the elongation at break of the P/E-2 treatment group was the largest, while the P/E-3 treatment group was the smallest; and E-3 treatment group had the least toughness. (4) Reagent residual assay showed that peracetic acid and ethanol have been verified to be removed from the allogeneic skin after washing, with low cytotoxicity within limits required. (5) The results displayed under the same processing time, the skins of P/E-1 group have the closest properties and structure compared to the raw material. Figures and Tables | References | Related Articles | Metrics

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Changes of type I and III collagen and matrix metalloproteinase 2 and 9 on the wound of diabetic foot ulcer with external application of medical collagen dressing Zhao Zixi, Xu Jun, Ding Min, Li Xiwen, Zhang Jinghang, Wang Penghua 2022, 26 (10):  1544-1550.  doi: 10.12307/2022.201 Abstract ( 832 )   PDF (25251KB) ( 156 )   Save BACKGROUND: Collagen has been widely used in the fields of oral cavity, blood vessel, nerve, bone and cartilage, but the application of collagen sponge in ulcer wound of diabetic foot is seldom studied. OBJECTIVE: To analyze the effect of medical collagen sponge on the expression of type I and III collagen and matrix metalloproteinase 2 and 9 in granulation tissue of diabetic foot ulcer wound. METHODS: Forty-six patients with diabetic foot ulcers, 25 males and 21 females, admitted to the Department of Podiatry, Metabolic Disease Hospital of Tianjin Medical University from January to December 2019 were randomly divided into two groups. The control group received dressing change and debridement. The experimental group was treated with collagen sponge on the basis of the control group. Wound area was recorded before treatment and 3, 7, 14 days after treatment. Wound healing rate was calculated. Granulation tissue was taken and immunohistochemical staining was used to observe the expression of matrix metalloproteinase 2 and matrix metalloproteinase 9. Western blot analysis was used to measure type I and III collagen protein expression. This study was approved by the Ethics Committee of Zhu Xianyi Memorial Hospital of Tianjin Medical University.  RESULTS AND CONCLUSION: (1) The wound healing rate of the two groups increased with the time of treatment. The wound healing rate of the test group was higher than that of the control group at 3, 7, and 14 days after treatment (P < 0.05). (2) With the treatment time prolonged, the deposition of matrix metalloproteinase 2 and matrix metalloproteinase 9 in wound granulation tissue decreased in both groups. The expression of matrix metalloproteinase 2 and 9 in the experimental group was lower than that in the control group at various time points (P < 0.05). (3) The expression of type I and type III collagen in the wound granulation tissue increased with the treatment time, and the expression of type I and type III collagen in the experimental group was higher than that in the control group (P < 0.05). (4) The results showed that medical collagen sponge could reduce the expression of matrix metalloproteinase 2/9 in wound tissue, promote the synthesis of type I and III collagen, and improve the wound healing rate. Figures and Tables | References | Related Articles | Metrics

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Effect of surface hardness of biomaterials in the phagocytosis of E. coli biofilm cells by macrophages Zhao Yanrui, Zhou Junlin 2022, 26 (10):  1551-1554.  doi: 10.12307/2022.202 Abstract ( 549 )   PDF (828KB) ( 105 )   Save BACKGROUND: Totally 60%-70% of hospital-acquired infections are related to medical devices of different materials, and bacterial biofilm cells play an important role in chronic infections. Bacterial adhesion and biofilm formation are affected by the characteristics of biological materials, such as surface charge, hydrophobicity, hardness, and surface chemistry. OBJECTIVE: To study the phagocytosis of macrophages on the early biofilm cells of E. coli on polydimethylsiloxane, a biomaterial with different surface hardness. METHODS: Hard (5:1), medium (20:1) and soft (40:1) polydimethylsiloxane with three surface hardness was prepared by controlling the mass ratio of base material and curing agent. (1) E. coli were inoculated on the surface of three kinds of hard materials to incubate bacterial biofilm cells. Activated macrophages were dropped onto the surface of each material. CFU cell counting, flow cytometry and inverted fluorescence microscope were used to detect the difference in macrophages Phagocytosis of E. coli biofilm cells on surface hardness materials. (2) Macrophages were inoculated on the surface of three hard materials, and then E. coli was added. CFU cell count was applied to detect macrophages phagocytosis of E. coli biofilm cells on materials with different surface hardness. RESULTS AND CONCLUSION: (1) Bacteria were inoculated first and then macrophages were added to the experiment: CFU cell count, flow cytometry technology and inverted fluorescence microscope detection showed that as the surface hardness of the material increased, the phagocytosis of macrophages increased and the number of E. coli biofilm cells decreased. The difference in the phagocytic rate of bacterial biofilm cells among the three groups was significant (P < 0.001). (2) Macrophages were inoculated first and then bacteria were added to the experiment: CFU cell count test showed that as the surface hardness of the material increased, the phagocytosis of macrophages increased and the number of bacterial cells decreased. It could be seen under the microscope that the macrophages were on the hard surface material more spread, with higher activity, and visible extension of pseudopods. (3) The results show that with the increase of the hardness of polydimethylsiloxane, the efficiency of macrophages phagocytosis of E. coli biofilm cells is higher. It is speculated that by optimizing the hardness of biological materials, endophyte-related infections can be better controlled. Figures and Tables | References | Related Articles | Metrics

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Dermal extracellular matrix hydrogel in promoting acute skin wound healing in rats Dong Hongfei, Huang Qilin, Yang Xiong, Li Shuai, Gu Rui, Sun Hongyu, Tang Lijun 2022, 26 (10):  1555-1560.  doi: 10.12307/2022.203 Abstract ( 556 )   PDF (34664KB) ( 62 )   Save BACKGROUND: Dermal extracellular matrix (d-ECM) has been widely used in clinical wound repair, but whether dermal extracellular matrix hydrogel (d-ECMH) can improve acute skin wound healing is still a lack of relevant research. OBJECTIVE: To explore the healing effect and mechanism of d-ECMH on acute skin wounds in rats. METHODS: Twenty-four SD rats were divided into model group, d-ECM group and d-ECMH group by random number table method, with 8 rats in each group. Firstly, all rats established a full-thickness skin defect model, and then the model group and d-ECMH group were immediately injected with equal volumes of PBS buffer and d-ECMH on the wound respectively after the operation, and the wound surface of the d-ECM group was covered with d-ECM to observe and evaluate wound healing. All rats were sacrificed on day 14, and the skin tissues of the wounds were subjected to hematoxylin-eosin staining, Masson staining, histoimmunochemistry and fluorescence staining. The experiment was approved by Animal Ethics Committee of General Hospital of Western Theater Command. RESULTS AND CONCLUSION: (1) The wound of rats in each group shrank with the prolongation of treatment time. Compared with the model group and the d-ECM group, the d-ECMH group had higher wound healing rate and wound surface skinization rate (P < 0.05), and reduced wound contracture rate (P < 0.05). (2) Hematoxylin-eosin staining showed that compared with the model group and the d-ECM group, the d-ECMH group had better skin wound repair and a higher degree of re-epithelialization of the wound, forming new skin appendages (such as hair follicles), and the matrix of dermis was more uniform. (3) Masson staining results showed that compared with the model and the d-ECM groups, the collagen fibers in the skin wound tissue were significantly increased and thicker in the d-ECMH group. (4) Immunohistochemical staining showed that the number of new capillaries in the skin wound tissue of the d-ECMH group was significantly more than that of the model group and d-ECM group (P < 0.05). The contents of tumor necrosis factor-α and interleukin-6 in wound tissues of the d-ECMH group were significantly lower than those in the model group and d-ECM group (P < 0.05). (5) Immunofluorescence staining showed that the number of M2 macrophages in the new wounds of the d-ECMH group was significantly higher than that of the model group and d-ECM group (P < 0.05), while the number of M1 macrophages was significantly lower than that of the model group and d-ECM group (P < 0.05). (6) The results show that d-ECMH can accelerate skin wound healing, promote wound re-epithelialization, and reduce wound contracture, which may be related to promote capillary angiogenesis and collagen fiber production, reduce inflammation and regulate the polarization of macrophages to M2 in the wound.  Figures and Tables | References | Related Articles | Metrics

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Changes in serum inflammatory factors and hemodynamics of biological mitral valve replacement for elderly patients with cardiac valve disease Zhang Yang, Zhao Qiaoyan, Zhai Jiwei, Li Jing 2022, 26 (10):  1561-1565.  doi: 10.12307/2022.204 Abstract ( 545 )   PDF (19369KB) ( 310 )   Save BACKGROUND: Mitral valve replacement with reserved subvalvular structure is an effective method for the treatment of valvular heart disease. The selection of prosthetic valve material plays an important role. OBJECTIVE: To explore application effect of biological mitral valve replacement in elderly patients with valvular heart disease. METHODS: Clinical data of 96 elderly patients with valvular heart disease who received mitral valve replacement from May 2017 to April 2019 in The 7th People’s Hospital of Zhengzhou were retrospectively analyzed. According to their conditions and wishes, the patients were divided into biological group (n=62) and mechanical group (n=34). The biological group received mitral valve replacement with reserved subvalvular structure biological valve. The mechanical group received mitral valve replacement with reserved subvalvular structure mechanical valve. Cardiac function, clinical efficacy, serum inflammatory factors, hemodynamics, and complications were compared between the two groups. This study was approved by the Ethics Committee of The 7th People’s Hospital of Zhengzhou (approval No. 20170315).   RESULTS AND CONCLUSION: (1) In follow-up for 12 months, New York Heart Association class I was 71%, and clinical success rate was 77% in the biological group. New York Heart Association class I was 47%, and clinical success rate was 53% in the mechanical group. There was significant difference of New York Heart Association class I and clinical success rate between two groups (P < 0.05). There were no cases of reoperation or death caused by structural failure of artificial valve in the two groups. The thromboembolism, endocarditis and perivalvular leakage were lower in the biological group than those in the mechanical group (P < 0.05). (2) At 3 days after surgery, mass concentrations of serum interleukin 6 and tumor necrosis factor α were lower in the biological group than those in the mechanical group (P < 0.05). The mass concentration of serum interleukin 10 was higher in the biological group than that in the mechanical group (P < 0.05). (3) In follow-up for 12 months, early diastolic inflow velocity and maximun transvalvular pressure gradient were lower in the biological group than those in the mechanical group (P < 0.05). Effective orifice area was higher in the biological group than that in the mechanical group (P < 0.05). (4) The results show that biovalvular mitral valve replacement helps to improve cardiac function of elderly patients with heart valve disease, increases the clinical success rate, and reduces complications, which may be associated with antagonistic inflammatory stress response and improving hemodynamics.  Figures and Tables | References | Related Articles | Metrics

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Prepared HPe6DF composite nanoparticles enhance the effect of photodynamic therapy Cai Shengsheng, Mei Heng, Zhang Xuequan, Deng Jin, Cao Jun, He Bin 2022, 26 (10):  1566-1573.  doi: 10.12307/2022.205 Abstract ( 534 )   PDF (62863KB) ( 128 )   Save BACKGROUND: The strong hydrophobicity and lack of targeting of commonly used photosensitizers seriously limit the therapeutic effect of photodynamic therapy. Although nanodrug carriers are capable of delivering photosensitizers to tumor sites, the tumor hypoxia microenvironment seriously weakens the efficiency of photodynamic therapy. Furthermore, the photodynamic therapy-induced immune response would also be limited due to the tumor immunosuppressive microenvironment.   OBJECTIVE: To synthesize the targeted nanoparticles and evaluate their physicochemical properties, the efficiency of enhancing photodynamic therapy and the feasibility of combined immunotherapy.  METHODS: Amphiphilic functionalized polylysine and NLG8189 dimer was synthesized by amino acid closed-loop reaction, ring-opening polymerization and condensation reaction. The core of nanoparticles (Pe6D) was prepared by the dialysis method, followed by the perfluoro hexane loading and hyaluronic acid wrapping to obtain the composite HPe6DF nanoparticles. Thereafter, the particle size, zeta potential, surface morphology, enzyme responsiveness, oxygen loading efficiency, and reactive oxygen species production of HPe6DF were studied. Mouse breast cancer cells 4T1 was served as in vitro cell model for the biological evaluation of HPe6DF nanoparticles, including cellular uptake, reactive oxygen species production, cytotoxicity, apoptosis, cell immunogenic death and inhibition of indoleamine-2,3-dioxygenase enzymes. RESULTS AND CONCLUSION: (1) Successfully prepared HPe6DF nanoparticles present uniform spherical morphology with a hydration diameter of 150 nm and the zeta potential is around -20 mV. Moreover, the composite nanoparticles have a certain hyaluronidase responsiveness, good oxygen loading ability, and active oxygen production ability. (2) The results of the cell compound culture experiment showed that HPe6DF nanoparticles accumulated in the cell in a time-dependent manner. Under the same other conditions, the fluorescence intensity of the hyaluronic acid pre-incubation group was significantly weaker than that of the non-hyaluronic acid pre-incubation group, proving that HPe6DF nanoparticles could enter the cell effectively through CD44 mediation. Under light conditions, HPe6DF nanoparticles had good reactive oxygen species production ability in cells, could promote cell apoptosis efficiently, and further induce immunogenic death, and can effectively inhibit the activity of indoleamine-2,3-dioxygenase in tumor cells. (3) The results show that HPe6DF nanoparticles can not only improve the photodynamic efficiency, enhance the immunogenicity of tumor cells, but also relieve the immunosuppressive microenvironment of the tumor site. Figures and Tables | References | Related Articles | Metrics

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Function on 3D printing poly(3-hydroxybutyrate-co-3-hydroxyvalerate)/calcium sulfate hemihydrate scaffold integrated chitosan hydrogel coating Ye Xiangling, Xia Yuanjun, Wang Boqun, Kang Zhengyang, Wu Bin 2022, 26 (10):  1574-1581.  doi: 10.12307/2022.206 Abstract ( 568 )   PDF (36994KB) ( 79 )   Save BACKGROUND: Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) was a new type of polymer with good biocompatibility and degradability. However, PHBV has strong hydrophobicity, and was not conducive to cell adhesion, growth, migration, and differentiation, which severely limits its application in the field of bone tissue engineering. Thus, it is necessary to further modify it. OBJECTIVE: To construct PHBV/calcium sulfate hemihydrate (CSH)/chitosan (CS) scaffolds, and explore its characterization and drug release behavior, biological safety, osteogenic properties and antibacterial activity in vitro. METHODS: PHBV and PHBV/CSH scaffolds with 20 wt% CSH content were prepared by fused deposition technology. The PHBV/CSH scaffolds were immersed in the chitosan solution and dried, and the dried scaffolds were put into ultrapure water to form a chitosan hydrogel on the surface of the scaffolds, termed the PHBV/CSH/CS scaffolds. The surface morphology, cell adhesion, and cell proliferation of PHBV, PHBV/CSH, PHBV/CSH/CS scaffolds were observed. The swelling behavior and simulated drug release behavior of the PHBV/CSH/CS scaffolds were tested. Alizarin red staining was used to evaluate the osteogenic performance of these scaffolds. The spread plate method was used to observe the antibacterial ability of each group of scaffolds against standard Staphylococcus aureus, standard Escherichia coli, clinical Staphylococcus aureus, and clinical Escherichia coli. RESULTS AND CONCLUSION: (1) The scaffolds all had a uniform and interconnected porous three-dimensional structure, with an average pore size of about 400 μm and a porosity of 60%. (2) The swelling rate of PHBV/CSH/CS scaffold was 56%. When using bovine serum albumin as a model drug, the loading rate of PHBV/CSH/CS scaffold was 57.9% at 1 hour, and the cumulative release at 6 hours was 56.5%. (3) PHBV scaffolds were not conducive to cell adhesion. PHBV/CSH scaffolds improved cell adhesion. PHBV/CSH/CS scaffolds significantly improved cell adhesion. (4) PHBV, PHBV/CSH, PHBV/CSH/CS scaffolds could promote the proliferation of bone marrow mesenchymal stem cells, and there was no obvious cytotoxicity in the three groups. (5) Alizarin red staining experiments showed that the PHBV/CSH/CS scaffold had a stronger effect on the formation of mineralized nodules in bone marrow mesenchymal stem cells than the other two groups. (6) In vitro antibacterial experiments showed that the PHBV/CSH/CS scaffolds were significantly stronger against standard Staphylococcus aureus, standard Escherichia coli, clinical Staphylococcus aureus, and clinical Escherichia coli compared with PHBV, PHBV/CSH scaffolds (P < 0.01). (7) These results confirm that compared with other scaffolds, PHBV/CSH/CS exhibits better cell adhesion, osteogenesis, antibacterial properties and drug loading potential. Figures and Tables | References | Related Articles | Metrics

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Repair and regenerative therapies of the annulus fibrosus Fang Xiaoyang, Tang Tian, Wang Nan, Qian Yuzhang, Xie Lin 2022, 26 (10):  1582-1587.  doi: 10.12307/2022.207 Abstract ( 1694 )   PDF (49711KB) ( 224 )   Save BACKGROUND: When the integrity of the annulus fibrosus is destroyed and the annulus fibrosus breaks, it will aggravate the protrusion of nucleus pulposus, and accelerate the degeneration of intervertebral disc, which finally lead to the occurrence of corresponding diseases. Therefore, restoring the integrity of the annulus is of great significance for the prevention and treatment of diseases. OBJECTIVE:  To review the research progress of annulus fibrosus repair and regeneration at home and abroad. METHODS: A comprehensive search was conducted for the studies published until December 2020 with the key words of “annulus fibrosus, repair and regeneration, tissue engineering, gel, cell therapy” in Chinese and “annulus fibrosus, repair and regeneration, tissue engineering, hydrogel, cell” in English on the CNKI, Wanfang and PubMed databases.  RESULTS AND CONCLUSION: Some progresses have been made in the mechanics and biology of annulus fibrosus repair and regeneration. At present, it is considered that mechanical repair of annulus fibrosus (annulus fibrosus suture, annulus fibroplasty and radiofrequency thermocoagulation) can only partially repair the outer annulus fibrosus and restore the disordered tissue structure, which is not worthy of further study. Biological methods of repairing and regenerating annulus fibrosus include gel, tissue engineering, biological patch and so on. Compared with mechanical repair, biological treatment can better restore full-thickness annulus fibrosus and restore relatively ordered structure, which is close to the structure and function of natural annulus fibrosus. However, there are still many problems: (1) selection and implantation of materials; (2) phenotype of annulus fibrosus cell is difficult to be confirmed; (3) the stability of long-term biomechanics is unknown; (4) lack of human experiments. Therefore, we can start from the above aspects and combine the cytology, biochemistry, materials science, mechanics and other disciplines to realize the repair and regeneration of damaged annulus fibrosus and its application in clinic as soon as possible. Figures and Tables | References | Related Articles | Metrics

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Molecular mechanism of bone regeneration promoted by medical metal implant materials Zhou Hongbo, Yu Zhengwen, Liu Jianguo 2022, 26 (10):  1588-1596.  doi: 10.12307/2022.208 Abstract ( 634 )   PDF (26298KB) ( 85 )   Save BACKGROUND:  It is of great significance for the design, processing and clinical application of medical metal implant materials to study the molecular mechanism of bone marrow mesenchymal stem cell osteogenic differentiation induced by different medical metal implant materials and to organize and analyze the comprehensive gene regulatory network of multiple osteogenic signaling pathways.  OBJECTIVE: To review possible molecular mechanisms of bone marrow mesenchymal stem cell osteogenic differentiation induced by medical metal implant materials to provide theoretical basis for clinical application of different medical metal implant materials. METHODS: The articles were searched in PubMed, CNKI, and Wanfang databases with the key words of “osteogenic differentiation, signaling pathways, bone marrow mesenchymal stem cells, bone defect, bone repair materials, oral and maxillofacial restoration, implant, alloys” in Chinese and English, separately. Finally, 51 articles met the criteria for review. RESULTS AND CONCLUSION: (1) Bone marrow mesenchymal stem cells are a kind of pluripotent adult stem cells and an important source of stem cells for tissue engineering. The Wnt/β-catenin pathway, MAPK pathway and bone morphogenetic protein/Smad pathway can regulate and induce osteogenic differentiation of bone marrow mesenchymal stem cells. After implanted into human body, medical metal implant materials can release metal ions or stimulate the body to produce various cytokines and produce cascading effects to promote osteogenic differentiation of bone marrow mesenchymal stem cells, so as to promote bone regeneration and repair bone defects. (2) This review summarized and analyzed the osteogenic signaling pathways (Wnt/β-catenin pathway, MAPK pathway, bone morphogenetic protein/Smad pathway, integrin pathway, phosphatidylinositol 3-kinase pathway, osteoprotegerin/RANKL/RANK pathway) involved in the promotion of osteogenic differentiation of bone marrow mesenchymal stem cells by different medical metal implant materials and bone repair materials with different surface treatments. (3) At present, many researches on the promotion of bone marrow mesenchymal stem cell osteogenic differentiation by medical metal materials in vitro and in vivo are mainly focused on a single signaling pathway, while multiple pathways related to osteogenic differentiation interact with each other and constitute a complex network. Current studies have not been able to fully reveal the specific mechanism of osteogenic differentiation. (4) From the perspective of osteogenic differentiation of bone marrow mesenchymal stem cells, we discussed and summarized the possible molecular mechanisms of different new medical metal implants regulating the induction of osteogenic differentiation of bone marrow mesenchymal stem cells, as well as the relationships among multiple signaling pathways and their roles. For example, when the Wnt/β-catenin signaling pathway is activated, it will stimulate cells to produce MAPK pathway and bone morphogenetic protein/Smad pathway initiating factors, such as epidermal growth factor and bone morphogenetic protein. These three signaling pathways work simultaneously. After entering the nucleus, it induces the transcription of osteogenic effect genes, thereby promoting the osteogenic differentiation of bone marrow mesenchymal stem cells, and forming a comprehensive gene regulatory network mechanism of multiple osteogenic signal pathways. Figures and Tables | References | Related Articles | Metrics

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Advantages and disadvantages of interbody implant materials in lumbar fusion Chen Zhengyu, Tong Jie, Li Xuelin, Yan Yiguo 2022, 26 (10):  1597-1603.  doi: 10.12307/2022.209 Abstract ( 814 )   PDF (18965KB) ( 529 )   Save BACKGROUND: In recent years, with the optimization and improvement of various new interbody implant materials, it has effectively promoted the development of interbody fusion, and the renewal of interbody implant materials provides an important basis for the improvement of interbody fusion. OBJECTIVE: To describe the development, advantages and disadvantages of all kinds of interbody implant materials commonly used at present, so as to provide some references for the selection of suitable interbody fusion materials in clinic. METHODS: Relevant articles in Chinese and English published in PubMed, CNKI, Wanfang and China Biomedical Literature Database from January 1990 to April 2021 were retrieved. Search terms were “Interbody fusion materials, Autogenous bone, Allogeneic bone, Hydroxyapatite, Titanium alloy, Tantalum, Polymer, Carbon fiber, PEEK, BMP2, Lumbar fusion, Lumbar interbody fusion” in English and Chinese, separately. After screening, 66 articles were included and reviewed.  RESULTS AND CONCLUSION: (1) At present, there are many kinds of interbody fusion materials used in clinic, which can be divided into autogenous bone, allogeneic bone, hydroxyapatite, titanium alloy/tantalum, polymer, and bone-induced composite materials. Each material has its own characteristics ,advantage, and scope of application. (2) From an objective point of view, autogenous bone transplantation is still the first choice for clinical lumbar interbody fusion, but its biggest deficiency is the limited bone collection and related complications in the bone donor area, which limits its clinical application. However, it also indirectly  promotes the sustained development of other intervertebral implant materials. (3) From the perspective of the development of interbody fusion, now more and more researchers further pursue the biomimetic fusion of the spine in order to achieve the reconstruction of physiological anatomy and function. (4) Nowadays, with the in-depth development of material science, tissue engineering, biomechanics and augmentation manufacturing technology, composite intervertebral implant materials or biological composite bone composed of inducing factors are used to replace internal implants. The advantages complement each other in the form of composite, which further improves the rate of interbody fusion and has a good development prospect in the field of spinal fusion. However, long research cycles and large clinical sample size are still needed to explore and prove the real clinical efficacy. Figures and Tables | References | Related Articles | Metrics

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Influence of surface treatment technology on friction and wear performance of artificial joints Liu Zhiqiang, Liang Yuyao, Gao Ge, Meng Shun, Xie Zhongqi, Su Yu 2022, 26 (10):  1604-1609.  doi: 10.12307/2022.210 Abstract ( 1028 )   PDF (24359KB) ( 298 )   Save BACKGROUND: Surface treatment technology has been widely used in biomedical field, which can effectively improve the friction and wear properties of artificial joints materials.  OBJECTIVE: Taking the friction and wear performance of artificial joints as the research object, to summarize the application and development of surface texture technology and surface coating technology in the friction and wear performance of artificial joints in recent years. METHODS: Studies on the surface treatment technology, friction and wear performance of artificial joints were searched by computer on ScienceDirect, SpringerLink, EBSCO, Web of Science and other databases. The retrieval words were “artificial joints, friction, wear, surface treatment/surface modification”, and the retrieval time was from March 2000 to June 2020. RESULTS AND CONCLUSION: Surface treatment technology is mainly divided into surface texture technology and surface coating technology. Surface texture technology will affect the microstructure of artificial joints, so as to optimize the performance of artificial joints. However, not all texture structures can improve the friction and wear performance of artificial joints. When the initial roughness value of the surface texture structure is too large, it will inhibit the hydrodynamic effect of the texture structure and weaken the friction and lubrication performance. Surface coating technology will affect the surface performance of artificial joints, thus increasing the service life of artificial joints. Figures and Tables | References | Related Articles | Metrics

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Application advantages of hydroxyapatite surface modification as a bone scaffold for tissue engineering Hou Jianfei, Wang Fuke, Yang Guiran, Liao Xinyu, Jia Di, Liu Dejian 2022, 26 (10):  1610-1614.  doi: 10.12307/2022.211 Abstract ( 668 )   PDF (19280KB) ( 314 )   Save BACKGROUND: Due to the large difference in physical and chemical properties between hydroxyapatite and polymer materials, poor interfacial compatibility and easy aggregation, the mechanical and biological properties of the composite materials are poor, which limits the application of hydroxyapatite in tissue engineered bone. OBJECTIVE: To review the methods of surface modification of hydroxyapatite for the preparation of tissue engineered bone in recent years, and to briefly discuss the reaction mechanism and effect of these methods. METHODS: On Wanfang, CNKI, VIP, PubMed Central Medine, Google academic databases, articles on the research progress of hydroxyapatite surface modification as tissue engineered bone scaffold were searched using the Chinese search term of “temperature sensitive gel, slow release, drug delivery pathway” and the English search term of “hydroxyapatite, surface modification, tissue engineered bone”.  RESULTS AND CONCLUSION: Up to now, a variety of materials surface modification methods, such as surface active agent, silane coupling agent and grafted polymer, have made some progress, but the effect of a modified method for single is still limited. We can consider putting two or many kinds of modification methods and the modifier in combination to complement each other for a better modification effect. Surface modification is not only to improve the dispersivity of the hydroxyapatite, and increase mechanical properties of the composites, but also will have biological activity, can promote bone regeneration of bioactive factors, such as peptides on the surface of hydroxyapatite, and thus improve the biological properties of composite materials, realize the control on the properties of hydroxyapatite, and the preparation of excellent performance of the tissue engineered bone. Figures and Tables | References | Related Articles | Metrics

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Characteristics and selection of grafts for posterior cruciate ligament reconstruction Zhao Zhenglü, Li Yanlin, Wang Xu, Liu Dejian, Zhang Yan 2022, 26 (10):  1615-1619.  doi: 10.12307/2022.212 Abstract ( 640 )   PDF (19195KB) ( 244 )   Save BACKGROUND: Arthroscopic reconstruction of posterior cruciate ligament has become the main treatment for severe injury of posterior cruciate ligament. Mastering the characteristics of all kinds of posterior cruciate ligament reconstruction grafts and selecting suitable transplantation materials are considered to be an important link affecting the effect of posterior cruciate ligament reconstruction.   OBJECTIVE: To summarize the advantages and disadvantages of autografts, allografts and artificial ligaments in posterior cruciate ligament reconstruction, and put forward improvement strategies and prospect.   METHODS: The first author searched the articles about implant materials (autografts, allografts and artificial ligaments) for the reconstruction of posterior cruciate ligament on PubMed database, CNKI database and Wanfang database from 2000 to 2020. The articles obtained in accordance with the search words were screened and retained, and the relevant articles related to the analysis of the advantages and disadvantages of all kinds of posterior cruciate ligament grafts were further analyzed and summarized in detail.   RESULTS AND CONCLUSION: Posterior cruciate ligament reconstruction grafts have their own advantages and disadvantages. At present, autogenous hamstring tendon grafts are most widely used in clinic. Ligament enhancement device, internal tension reduction technique or tendon surface coating technology can improve the effect of posterior cruciate ligament reconstruction. Autogenous tendons, allogeneic tendons and artificial ligaments are all important sources of posterior cruciate ligament reconstruction grafts in the short term. With the progress of artificial ligament and tissue engineering ligament research in the long term, it is expected to completely solve the problem of posterior cruciate ligament reconstruction materials. When selecting posterior cruciate ligament grafts, surgeon should consider the level of activity expected by patients, the types of activities they participate in, their professional characteristics, the reconstruction techniques and habits mastered by doctors, and the fixed materials matched with the grafts, so as to select a suitable posterior cruciate ligament reconstruction graft. Figures and Tables | References | Related Articles | Metrics

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Application of biomaterial and tissue engineering in reconstruction of tympanic membrane defect Wen Ke, Lu Yanqing, Hou Nan, Ma Ruina, Cui Pengcheng, Lü Die, Xu Xiaoli 2022, 26 (10):  1620-1624.  doi: 10.12307/2022.213 Abstract ( 602 )   PDF (18850KB) ( 442 )   Save BACKGROUND: The use of tissue engineering technology to repair perforated tympanic membrane can effectively reduce the incidence of postoperative complications. OBJECTIVE: To review the research progress of repairing materials for tympanic membrane perforation. METHODS: The computer was used to retrieve databases, including PubMed, Web of Science, Wanfang, and China National Knowledge Infrastructure. English literature published from 2000 to 2020 and Chinese literature published from 2018 to 2020 were retrieved. Key words in English were “tympanic membrane, acute/chronic tympanic membrane perforation, tissue engineering”; key words in Chinese were “tympanic membrane perforation, tissue engineering”. Finally, the clinical feasibility and repair prognosis of each method were summarized. RESULTS AND CONCLUSION: Tympanic membrane perforation can lead to hearing loss and repeated ear abscess, affecting the quality of life to patients seriously. Tissue engineering technology is a trend to repair tympanic membrane perforation, which can also have the function and structure of the original tympanic membrane without the risk of being taken from autologous materials. Tissue engineering of tympanic membrane repair includes three elements: seed cells, scaffold materials (providing mechanical support for cell expansion, migration and differentiation), and bioactive substances (providing suitable microenvironment for tissue growth). Tissue engineering materials can reduce the risk of infection and hematoma caused by acquiring autologous tissues as repairing materials, and can also be selected according to the situation of tympanic membrane perforation, which provides a new research directions and treatment solutions for repairing tympanic membrane. Figures and Tables | Related Articles | Metrics

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Research progress on the application of self-assembled peptides in endodontics and periodontitis Huang Lan, Wang Qin, Ge Song 2022, 26 (10):  1625-1630.  doi: 10.12307/2022.214 Abstract ( 788 )   PDF (33004KB) ( 241 )   Save BACKGROUND: With the more and more in-depth study of self-assembled peptides, it is considered to be a potential biomaterial because of its non-toxicity and good biocompatibility, which provides an application prospect for the treatment of stomatology in the future.  OBJECTIVE: To review the application of self-assembled peptides in the field of endodontics and periodontitis, as well as the challenges and trends that may be faced in the future. METHODS: Chinese and English search words were “self-assembling peptides, periodontal disease, dental pulp stem cells, regenerative medicine, tissue engineering, dental pulp-cytology”. The related articles about self-loading peptides were searched on CNKI, Wanfang and PubMed. The retrieval time was from 2005 to 2021. Finally, 63 articles were selected by abstract search, and systematically summarized, and analyzed to comprehensively describe the new progress and challenges of self-loaded peptides in the field of stomatology.  RESULTS AND CONCLUSION: (1) Self-assembled peptides are a kind of biological nanomaterials in which amino acid molecules assemble spontaneously and reversibly through intramolecular/intermolecular interactions. (2) A large number of experimental studies have shown that self-assembled peptides as a scaffold can promote cell proliferation, differentiation, migration and production of extracellular matrix components and induce angiogenesis, which is widely used in dental pulp and periodontal tissue regeneration. (3) However, at present, there are still some shortcomings, such as the variability of stability in different states, lack of mechanical properties, and uncertain immunogenicity, which suggests that we should focus more on how to enhance the stability of the structure in future research, improve mechanical strength and design more functional self-assembled peptide scaffolds. (4) At this stage, a large number of basic researches tend to show that the combination of self-assembled peptides and dental pulp stem cells has more tissue regeneration and osteogenesis capabilities than dental pulp stem cells alone. (5) Because self-assembled peptide has its own stability disadvantages, the long-term efficacy applied to the clinic still needs more clinical trials to confirm, but this does not prevent it from becoming the focus of future research, and it opens up a new way for the treatment strategy in the field of dental pulp periodontology. Figures and Tables | Related Articles | Metrics

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Application advantages of concentrated growth factors in the field of tissue repair and regeneration Zhou Yi, Liu Xiaoyan, Xiang Bingyan 2022, 26 (10):  1631-1640.  doi: 10.12307/2022.215 Abstract ( 782 )   PDF (19262KB) ( 243 )   Save BACKGROUND: As the latest generation of autologous platelet concentrate biologics, concentrated growth factor has become a research hotspot in the field of tissue repair and regeneration due to its natural fibrin scaffold and abundant endogenous growth factors. OBJECTIVE: To summarize the research progress of concentrated growth factors in the field of tissue repair and regeneration, as well as discuss the existing problems in the current research stage, in order to provide new reference ideas for the follow-up research of concentrated growth factors. METHODS: This article used “concentrated growth factor, CGF, stem cells, tissue repair, tissue regeneration” as search terms. A comprehensive search was conducted on PubMed, EMbase, Medline, and CNKI. The relevant research evidence of the application of concentrated growth factor in the field of tissue repair and regeneration in the past 10 years were collected and summarized. The literature was screened based on strict inclusion and exclusion criteria. Finally, 96 articles were included.  RESULTS AND CONCLUSION: (1) This article summarized the research progress of concentrated growth factor from four aspects: the specific method of preparation and application of concentrated growth factor, the principle of concentrated growth factor promoting tissue repair and regeneration, the effect on cell proliferation and differentiation in vitro, and the repair and reconstruction of tissue in vivo, and discussed the current research the existing problems. (2) Concentrated growth factor is an autologous bioactive factor with potential in the field of tissue repair and regeneration. The preparation method is simple and the application method is flexible and changeable. It is completely taken from autologous blood, so that it has great biocompatibility and few immune rejection reactions. (3) The core structure of concentrated growth factor includes a natural fibrin scaffold and a variety of endogenous growth factors, which can promote the proliferation, migration and differentiation of a variety of stem cells in vitro. (4) Concentrated growth factors can promote the repair of bone defects in vivo, and the local growth factor slow-release system constructed by combining it with tissue engineering materials is an effective way to extend the slow-release time of growth factors. (5) Concentrated growth factors have shown great effects in promoting soft tissue repairing, anti-skin photoaging, and reducing postoperative complications. It has become one of the preferred options for personalized treatment of autologous bioactive preparations. Figures and Tables | References | Related Articles | Metrics